
-^4 



V 






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REPORT OF 



Five Years of Mouth Hygiene 



in the 



Public Schools of Bridgeport, Conn. 



By ALFRED C. FONES, D.D.S. 

Director of the Dental Department of the Bridgeport^ Conn, Board of Health 



LIBRARY OF CONGRESS 

APR J 819^1 

DOCUMENTS U, Virion 



\s^% 



Report of five Vears of mouth Byglene In the Public Schools 

of Briageport, Conn. 

By Alfred C. Fones, D. D. S. 

Director of the Dental Department of the Bridgeport, Ct., Board of Health 

Read before the Convention of the Connecticut Dental Hygienists' Asso- 
ciation, Bridgeport, Conn., May 24th 

In presenting a report of the findings of a five-year demonstration of 
an educational and preventive dental clinic in the first five grades of the 
public schools of Bridgeport, Conn., it is interesting to review the reason- 
ing and deductions by which the plan was perfected. Previous to the 
establishment of the clinic in 1914, a paper entitled *'A Plan that Solves 
the Fundamental Problem in School Hygiene" was read by Dr. Alfred 
C. Fones, of Bridgeport, Conn., before the Fourth International Con- 
gress on School Hygiene in Buffalo, August 26th, 1913. In it the author 
summed up in a short article the physical status of the average school 
child and the problem of the unsanitary condition of his mouth, and 
evolved a plan for its solution. At that period little was known of focal 
infections, which have proven to be a greater evil than anything yet recog- 
nized as traceable to decayed teeth. The paper makes a logical intro- 
duction to this report and is presented in full as follows : 

"To analyze the subject of hygiene for the up- 

Dr. Tones' $ Plan lift and betterment of the children in our public 

rfOPOSCd m schools, we must determine what are the main factors 

1914 

existing at present that act as a detriment to proper 

development and also as the chief cause of illness in child life. 

"The large number of papers presented at this congress, covering so 
many phases of the subject, merely proves that we must reach a con- 
clusion, first as to where we should concentrate our energy, and then 
one step at a time eliminate the most conspicuous evils that beset the 
school children of our country. 

"If our large steel plants and rolling mills were obliged to reroU from 
twenty to thirty-five per cent, of their stock, it would not take them 
very long to find out what was the matter. No business now-a-days could 
stand such a high percentage of loss in doing its work over again. 

"In our public schools throughout the country it is a fair estimate 
to say that the percentage of grammar school children who are review- 
ing their grade will range between twenty and thirty-five per cent. In 
a majority of the cities the average would be nearer the latter figure. 
What is the matter? Is it our system of teaching, crowded schools, 



poorly lighted or ill-ventilated buildings, or is the chief cause to be 
found in the material itself — the child? 

"Let us examine the average boy of ten years of age and see what 
we find. Face, ears and nose unclean, hair unkempt, hands grimy and 
finger-nails dirty. Shoes splashed with dry or wet mud, clothes soiled, 
and an odor percolating through the atmosphere to excite suspicion that 
his little body has not been washed for some time. His eyesight may 
be good and yet it may be defective. ' If his face is washed it may 
disclose a color that is lacking in the bloom that a boy of ten should have. 

"If otherwise his body appears normal we ask him to open his mouth. 
If his external appearance troubles us, his internal appearance would 
shock us. Here we find teeth covered with green stain ; temporary and 
permanent teeth badly decayed, possibly fistulas on the gum surface 
showing an outlet for pus from an abscessed tooth or teeth, and decom- 
posing food around and between the teeth. Why examine the child any 
further? Here at the gateway of the system is a source of infection 
and poison that would contaminate every mouthful of food taken into 
his body. With decomposition instead of digestion taking place in the 
alimentary tract, it is no wonder that the child suffers from an auto- 
intoxication which produces eye-strain, anaemia, malaise, constipation, 
headaches, fevers and many other ailments. 

"Such a mouth is an ideal breeding ground for germ life, and a 
child with such a mouth is far more susceptible to infectious diseases 
than one whose teeth are sound and kept free from food debris. Sup- 
pose at the entrance of our cities such a rank condition existed. How long 
would it be before disease and sickness would be swept in among the 
inhabitants? This boy described is but duplicated in the girl of ten. 
Decayed teeth constitute the most prevalent disease known. It is diffi- 
cult to find two children out of one hundred with perfectly sound sets 
of teeth. In a thorough dental examination of five hundred and fifty 
school children in the town of Stratford, Connecticut, but one child was 
found to have a set of teeth free from decay. 

"Look over the reports of the medical inspectors in the public schools 
who have made but a glancing examination of the mouths, and you will 
find that decayed teeth outrank all other physical defects combined. 

"Therefore we must deduce from our analysis of school hygiene that 
the most conspicuous defect of the child is the unsanitary condition of 
his mouth. Like a pig pen or garbage drain, slowly seeping its poison 
into the brook, which, flowing into the reservoir, contaminates the water 
supply to a city, so do the products of abscessed and decayed teeth with 
decomposing food slowly but surely poison the human system. Such 

?4 



mouths and teeth breed disease. Such children cough and sneeze milHons 
of germs made virulent and active in an ideal feeding ground. And 
then again the teeth as a crushing and masticating machine are fre- 
quently ruined by the time the child has reached twelve or fourteen 
years of age. It is true that they can limp through life with this dread- 
ful handicap, the same as an automobile can climb a steep hill on three 
cylinders, but you can rest assured that the child with a wrecked mouth 
at fourteen is traveling on his second speed until he reaches thirty-five, 
and from there he drops into his low gear to finish the journey in a 
slow and uncertain state. It is true th^ many have lived to a ripe old 
age with unclean mouths and wrecked teeth, not on account of such 
conditions, but in spite of them. 

"If it be conceded that the most unhygienic feature of child life is 
its mouth we then come to the problem — how can we establish clean 
mouths, sound teeth and tooth-brush habit? To try and fill the teeth 
of the children in our public schools is a noble charity, but an endless 
chain. Like an immense flood, decayed teeth have spread over the civ- 
ilized world to such an extent that hardly one-tenth of the population 
of a country such as ours could find a sufficient number of dentists to 
fill its teeth. I believe it to be a conservative estimate to say that the 
children found in the first five grades in our public schools would aver- 
age not less than six* good-sized cavities in their teeth. If you will 
but figure out how many children there are in your city in the first five 
grades, you can roughly estimate the immense amount of work there 
would be for a corps of dentists to cope with such a task as filling 
their teeth. This would not mean merely plugging a hole in a piece of 
ivory; it means the painstaking work of a dental operation on live tissue. 

"But let us assume that it is possible to fill these teeth and save them 
for the time being, how are we to prevent a re-occurrence of decay as 
well as to check the flood with the children coming into the schools in 
the primary grades each year? Surely every dentist knows that the 
tooth brush alone will not stop it, and every dentist also knows, as well 
as the parent, how difficult it is to induce children to properly brush 
their teeth and take care of their mouths as they should. Would it not 
be better to evolve a system for the prevention of dental decay and the 
establishment of clean mouths than try to cope with the hopeless task of 
filling the thousands of decayed teeth? I am heartily in sympathy 
with the scheme that every city should have a dental clinic for the school 
children for the relief of pain, and I believe it is inhuman in this twen- 
tieth century to allow the poorer class of children to suft'er as they do 



*Later findings showed seven — plus. 



from toothache. But let us draw a Hne on the conditions as they exist 
today, and I would present this plan, partly suggested by Dr. Ottolengui, 
of New York, for your consideration. 

"It is a clinical fact that fully eighty per cent, of dental decay can 
be prevented, if monthly or even bi-monthly surface polishing of the teeth 
with orange wood sticks and fine pumice can be systematically followed. 
These treatments, of course, to be augmented by the faithful and cor- 
rect use of the tooth brush, floss silk and lime water as a mouth wash. 

"Suppose it were possible to start a year from this September and 
place in our schools trained women who would confine their efforts the 
first year to the children in the first grade. These women to be trained 
and educated as hygienists who would be competent to give each child 
a surface treatment of the teeth once a month ; each woman to have the 
supervision, to start with, of two hundred children ; these children in 
the first grade to be taught the proper use of the tooth brush, mouths 
inspected daily for cleanliness, and no child permitted to enter the class 
room who had not brushed his teeth. Hands and face to be clean 
and hair combed. Bodily cleanliness also insisted upon and efforts 
made to secure the co-operation of the parents. Talks in the class room 
as well as the use of the stereopticon in the assembly room would greatly 
aid in securing the desired results. These hygienists could also be of 
great aid to the medical inspectors. At the end of the year they would 
follow the children into the second grade and a new corps of hygienists 
would enter the first grade with the new pupils ; this to be repeated for 
five years, until the first corps of women were caring for their children 
in the fifth grade. It is doubtful if it would be necessary to carry this 
work beyond the fifth grade, as the child would be cared for through 
the most susceptible period for dental decay. 

"Now what would such a system mean to the children? It would 
mean that from the first day that the child entered school it would be 
taught cleanliness. That when the first permanent tooth entered the 
mouth it would be under the supervision of the hygienist, who would 
teach the child how to keep it clean and who would also aid with the 
monthly polishing. It would mean that during the first five years of 
school life habits of cleanhness would be established that would mold 
these boys and girls into new types of men and women. Fully three- 
quarters of the diseases incident to child life would be eliminated. With 
an additional knowledge of food values and how to properly masticate 
their food instead of bolting it, the main factors for hygiene would 
be covered. 

"Booker Washington once said: 'If I can teach the colored man the 



gospel of the tooth brush, I feel that I can make a man of him.' Those 
of you who see but little of children can hardly realize what an uplift 
and different point of view there comes with a clean mouth and pol- 
ished teeth. It is interesting to see a child whose teeth have been pol- 
ished and a washbowl instruction given in the use of the tooth brush, 
gradually change in general appearance regarding cleanliness. I have 
known them in a few weeks to choose a new set of companions because 
the old friends no longer looked attractive to them. No one ever saw 
a rowdv with a clean mouth, for cleanliness breeds refinement. The 
proper food supply to the body and cleanliness are the two main founda- 
tion pillars for health, and these must be taught and practiced before 
we can hope to obtain satisfying results in the betterment of child life. 
There is much in life worth while besides teeth, but I know of no one 
factor that is more conducive to health than sound teeth and a clean 
mouth. 

"The question may be asked : How are we to educate these women to 
be dental hygienists ? In every large city there are men in both the medi- 
cal and dental professions who are competent to establish a lecture course 
for this purpose. The necessary training in the prophylactic treatment 
of the teeth would, of course, be given by dentists. Both of these pro- 
fessions are anxious to aid in any cause so worthy, and I believe they 
w^ould willingly give their time and knowledge to start such a move- 
ment. It is impossible in this paper to give the details concerning the 
education of these women and their full duties in the schools, but enough 
has been stated to permit those in charge of our public school system 
to consider the proposition in a general way and determine if this plan 
is a solution of the main problem regarding school hygiene." 

For four years previous to 1913, strenuous ef- 

Tnceotion forts had been made to interest the city officials of 

Of the Bridgeport Bridgeport to provide funds for an educational and 

experiment preventive dental clinic in the public schools. At 

last five thousand dollars was apportioned to the 

Board of Health in order that a demonstration might be made to prove 

the value of a mouth hygiene campaign conducted on an educational 

and preventive plan. 

With the possibility of this movement being a powerful aid in the 
prevention of dental decay, infectious and communicable diseases, eigh- 
teen prominent educators in the East agreed to come to Bridgeport and 
give their services gratis to educate a corps of women to be known as 
dental hygienists. The course was started in the late fall of 1913, 
and in June, 1914, the first class of dental hygienists was graduated. 



The Board of Health appointed a committee of four dentists and one 
member of the Health Board, a physician, to establish the system in 
the schools. Eight dental hygienists and two supervisors were chosen, 
and in September, 1914, the work was begun for the first and second 
grade children. 

There were four distinct parts to the system. 

T><t fiuaVnkK First, the prophylactic treatment or the actual clean- 

at lUorK In ^^S ^^^ polishing of the children's teeth and chart 

Public Schools examination of the mouths. Second, tooth-brush 

drills and class-room talks. Third, stereopticon lec- 
tures for children in the higher grades ; and, fourth, educational work 
in the homes by means of special literature for parents. The prophylac- 
tic treatment consisted mainly in the thorough cleaning, by means of 
orange wood sticks in hand polishers, of every surface of every tooth. 
This meant that the dental hygienist would remove all stains and accre- 
tions from the surfaces of the teeth, and especially the mucilagenous films 
known as bacterial placques, which are the initial step of dental decay. 
The treatments were given in the schools, the equipment being portable 
and adapted to almost any location. Every child received the same treat- 
ment, regardless of the financial status of the parent; in short, this 
preventive system was incorporated as part of the school curriculum. 
Some parents objected, thinking the work was a charity, but with a 
better understanding of it the objections were soon withdrawn. 

The tooth-brush drills were given by the supervisors, and a method 
of mouth brushing was taught for use in the home. No attempt was 
made to use water and a dentifrice in the class room, as this would prove 
to be too mussy. Class-room talks concerning foods, cleanliness, etc., 
were part of the drill. The total number of children examined and 
treated in the first and second grades the first year was 6,768. On the 
first examination less than ten per cent, were brushing their teeth daily. 
About thirty per cent, claimed that they brushed their teeth occasionally, 
while sixty per cent, were frank enough to state that they did not use a 
tooth brush. Ten per cent, of the children were found to have fistulas 
on the gums, showing the outlets of abscesses from the roots of decayed 
teeth, and they averaged over seven cavities per child. It was shocking 
to find the mouths of these children ranging from five to seven years 
in this deplorable condition, and it was appalling to contemplate the 
conditions that would exist in these mouths as the children grew up. It 
presented very interesting material to work with. 

It will take a long period of public education before the mouths of 
the incoming children to our first grade will show any great degree of 



improvement. From birth to five or six years of age they are entirely 
tinder the home influence and are permitted to eat foods, especially 
sweets, that are conducive to decay, and mouth cleanliness is not com- 
pulsory. Slowly but surely the public school education will seep back 
into the homes, and with the aid of the older children and pamphlets 
it is our hope that eventually the mouths of these children will present 
a much improved condition. 

In September, 1915, six additional hygienists were 

Corps of added to the corps to advance the work to cover the 

llVdieniStS first three grades. This gave a sufiicient number of 

Tncrcased workers until 1917, when six more were added, so 

that this care could be given to all the children in the 

first five grades, numbering about 15,000. 

In January, 1918, the parochial schools petitioned the Board of Health 
and also the Board of Apportionment to have this system extended to 
them as a health measure. This petition was granted and in September 
six more hygienists were added to the corps for this purpose, making 
twenty-six in all. At the present time these women have under their 
care the mouths of nearly twenty thousand children in the first five 
grades. 

We have also employed three women dentists, who are filling the 
small cavities in the first permanent molars for the children in the first 
and second grades. Many of these children, on entering school, have 
.small cavities developing in these most important teeth, and in order 
that all the children may start on an equal basis in the future preven- 
tion of dental decay of the permanent teeth, all are eligible and are en- 
couraged to have these small cavities filled. 

In order to prove definitely the value of educa- 
€xamination ^^^^ ^^^ prevention, it was necessary to have data 

Of fifth of the condition of the mouths of children in a 

Grade Cbildrcn higher grade who had never had the advantage of 
prophylactic treatments, tooth-brush drills, and edu- 
cation in mouth hygiene. The children of the fifth grade were chosen 
as the control class, and this report will present the comparison of their 
mouth conditions with the present fifth graders, who have had prophy- 
lactic treatments and education in mouth hygiene for the first five years 
of their school life. They have had no repair work provided for them 
and the educational side has been three-quarters of the work of the 
dental hygiene- cc^rps. 



In making this demonstration it was not our expectation to make a 
startling reduction in the percentage of dental decay, the main object 
being to show up the pernicious mouth conditions prevailing among 
school children and to prove the value of prevention and education in 
mouth hygiene for great numbers of children in preference to exten- 
sive repair clinics, with no effort to eliminate the source of the trouble. 
It would, of course, have been ideal to have had the two types of clinics 
and to have put the children's mouths in sound condition, but funds were 
not available for this purpose, and the excellent report shown is merely 
the result of education and prevention. 

For the purpose of securing this data a complete record chart has 
been maintained of the condition of every child's mouth at each successive 
treatment, and the following figures were obtained by comparing the 
average number of cavities per child in the fifth grade of a given school 
with the average secured from the same grade of the same school sev- 
eral years ago. The demonstration was conducted in thirty schools 
and this year twenty thousand individual children received this treat- 
ment and education. > 

Dental paries 

Following is the percentage of reduction of cavities in the permanent 
teeth of the fifth graders in these schools: 

The highest was Barnum school, which showed a reduction of 67.5%. 

The following five schools were over 57% : Huntington Road, Kos- 
suth, Prospect, Grand and Sheridan. 

Two schools, Maplewood and Franklin, showed over a 50% reduction. 

Three schools, Summerfield, Lincoln and Staples, were over 40%. 

Washington, Wheeler and Black Rock were over 30%. 

Newfield, Garfield, Hall, Jackson and Shelton were over 25%. 

Bryant, Elias Howe and Madison were over 20%. 

Those over 15% were Waltersville, Jefferson, Longfellow, Columbus 
and Webster. 

One school, Read, was below 10%, and two schools, Whittier and 
McKinley, showed a minus record. 

The total average for all these schools amounts to 33.9%. 

Although the principals and teachers have given splendid co-operation 
in many of the schools that have low records, they had to contend with 

10 



a certain number of children whose home influence was not conducive 
to any interest in mouth hygiene. 

The two schools which showed a minus record 

DtffkUlties were unfortunate enough to have a number of chil- 

lllcf mifb dren who were so absolutely negligent in the care 

of their mouths that they dragged down what would 

have been a reasonably good average by three-quarters of the children. 

Bridgeport has been one of the most difficult cities in which to carry 
on a demonstration of this kind. We have a large foreign population 
of which many parents do not speak English. Being a munition center 
during the war period, the population increased many thousands, over- 
crowding the city and schools. The school records showed in the past 
year that 58 per cent, of the children changed addresses and that the 
population was constantly shifting. The principals and teachers were 
occupied with many war duties, such as Junior Red Cross, thrift stamps. 
Hoover programs, etc. In short, no period could have been more 
unpropitious for a serious demonstration of this kind. 

Aside from this, the value of education and prevention has, with 
deliberate intent, been put to the hardest possible test. No effort has 
been made to address or educate the teachers or to enforce co-operation 
through the office of the superintendent of schools. The supervisors and 
dental hygienists have been permitted to win their own way, so that it 
might be demonstrated that what was accomplished in Bridgeport could 
be accomplished in any city. 

Wg believe that from 70 per cent, to 80 per cent. 
Reduction ^^ dental caries can be eliminated through the public 

of Dental Carles school system by the incorporation in the school cur- 
riculum of a definite health program, making hygiene 
one of the requisites for promotion. This would insure the co-operation 
and interest of the child, teacher and parent. 

The elimination of dental decay is so dependent upon factors other 
than cleanliness and education in mouth hygiene that it is surprising to 
note the large reduction in many schools. The most important factor is 
that of diet, and co-operation in this matter can be secured only after 
many years of education. The correct feeding of a child from birth 
to twelve years would in itself partially, if not wholly, eliminate dental 
decay. The education of mothers regarding the feeding of children 
after they reach an age when milk does not meet the requirements of 
the body is very essential, but it is necessarily slow, and little co- 
ll 



operation can be secured at this time. The most important factor would 
be the eHmination of free sugar from the diet. This seems radical to 
the vast majority of our people who consume ninety pounds of sugar 
per capita a year and look upon it as a food and a necessary part of 
the diet. This is an erroneous idea, since nature has provided all the 
sugar that the body requires in various common foods, as milk, fruits, 
some of the vegetables, etc., besides providing that all starchy foods, 
such as pastries, bread, macaroni, rice, etc., be changed into sugar in 
the digestive process. 

The excessive consumption of free sugar is undoubtedly the cause 
of exceedingly poor teeth among the English, French and American 
peoples. 

It is not hard to imagine that a very large percentage of children 
are constantly laboring under a handicap of faulty feeding which in 
turn produces a long line of other handicaps, such as malformed jaws, 
decayed teeth, under development, malnutrition, etc., while the most 
normal conditions could be secured by correct diet and cleanliness. 

nidlocclusion 

Aside from dental decay, the most noticeable defect in the mouths 
of the school children is lack of proper relationship between the jaws and 
teeth, or malocclusion. The symmetrical development of the brain case 
and the bones of the face, as well as good digestion, is dependent upon 
a perfect masticating machine. It was astonishing to note that malocclu- 
sion was present in 98 per cent, of all the children examined in the past 
five years. This deporable condition could be remedied to a great degree 
by the feeding in early childhood of the hard, coarse foods requiring 
pressure to thoroughly masticate, and by the prevention of any pernicious 
habits, such as thumb sucking, the use of pacifiers, mouth breathing, etc. 
Undoubtedly adenoids would be prevented to a marked degree if the 
roof of the mouth could be broadened and lowered by such pressure 
exerted in chewing. This would permit of wide nasal cavities that would 
be conducive to nose breathing and proper functioning of the nasal 
passages. 

is: I When but two per cent, of our school children have regular teeth it 
adds to the difficulty of eliminating dental decay, since irregular teeth 
off er the Jgreatest opportunity for the formation of cavities and render 
the thorough cleansing of the mouth very difficult. 

12 



Ketardation 

Our modern city school systems all have a smaller or greater per 
cent, of retarded pupils. The test of the success of any city school sys- 
tem at any given times is not whether there be at that time a large 
percentage of retarded children, but whether a decided trend can be 
traced toward an increase or decrease in percentage of such retarded 
children. 

Retardation is a serious matter from the standpoint of the pupil, the 
parent, the teacher, and the community. Retardation means re-educa- 
tion, and this in turn means the application of public funds for repeat- 
ing the operation. In the figures given below the very liberal standard 
adopted for retardation permits the child to be two years older than 
his grade would warrant and still be classified as regular. Those who 
are more than two years older than entering the first grade at the age 
of five would indicate are classified as retarded. 

The statistics at hand in the office of the Board of Education are 
not available year by year, but two general surveys have been made — 
one during September, 1912, and the other in November, 1918. These 
surveys, called the Age-Grade Report, immediately precede the open- 
ing of our work and occur near the close of the first five-year period, 
and so ofifer rather unusual opportunity for inference as to the effects 
produced. Reduced to a percentage basis, the changes that have taken 
place in the matter of retarded pupils in the grammar schools are sum- 
marized in the following table : 

Percentage of Retardea Pupils 

Drop in 

Grade Sept., 1912 Nov., 1918 Retardation 

I 16.5% 8.1% 51% 

II , 37. 15.3 58 

III 53. 24.7 53 

IV 59.5 31.7 47 

V 61. 33.1 45 

VI .54. 30.4 44 

- VII 39. 19.3 50 

VIII 27. 12.5 54 

Average 40. % 20.1% 50% 

This reduction of retardation by 50 per cent, is a really wonderful 
ehange to be accomplished in any school system in a period of five or 

13 



six years. Few people have realized the cost in money — which is only 
one of the evils of retardation — of the re-education of our retarded 
children. By actual figures the following statement holds true : 

Cost for re-education in Bridgeport, 1912, equals 42% of entire 
budget. 

Costs for re-education in Bridgeport, 1918, equals 17% of entire 
budget. 

One has only to consider the financial side to recognize that any 
reduction in retardation is an accomplishment devoutly to be sought 
through all legitimate means. Bridgeport has been moving distinctly 
forward in this matter. 

That this change has been a vital one to the self-respect of the pupils 
and in the advance of the moral conditions of the normal children is 
easily realized when one stops to consider the change in the location 
in our grades of the pupils fourteen years old and over that has come 
about during this same 1912-1918 survey. 

Pupils fourteen years old or over 

I II III IV V VI Grades 

212 — 4% of elementary pupils 
155 — 1.5% of elementary pupils 

Nor does this tell the entire story. As a result of the 1912 survey 
the following statement is made : "During the fifteen months ending last 
December, 1,356 children in Grades II to VI, all of the retarded class 
and over fourteen years of age, left school to go to work." Examina- 
tion of the records of the State Examination Board reveals the fact 
that during the same period of the last year less than 300 pupils, all of 
whom came from grades V and VI, received working certificates. 

Another effective proof of the great forward movement that has 
taken place in the lower grammar school grades is submitted in the fol- 
lowing form : 

In 1912, 60 per cent, of all the children registered in the grammar 
schools were below the fourth grade, while in 1918 but 50 per cent, 
were below the fourth grade. Similarly, in 1912, 85 per cent, were 
below the sixth grade, and in 1918 but 7^ per cent, were below the 
sixth grade. 

Without taking into consideration the physical condition of the chil- 

14 



Sept., 1912 . 


. 13 


17 


58 


107 


169 


Nov., 1918 . 


. 





11 


35 


109 



dren, educators claim that the three major factors producing retarda- 
tion are : 

1. Overcrowded class rooms 

2. Uninteresting and unsuitable courses of study 

3. Unqualified teachers 

Regarding the first, the following situation is interesting to note: 

Average pupils per teacher, 1912, 38 

Average pupils per teacher, 1918, 40 

The cause for reduction in retardation does not lie here. This has 
been rather a hindrance to its reduction. 

In regard to the course of study, a very effective reorganization of 
the subject matter in arithmetic, geography, language and history has 
been made within the past three years, and that, no doubt, has had a 
large influence in the matter of producing an interest in their work 
on the part of the pupils. This must have had a very potent influence 
in reduction of retardation. 

With respect to the matter of teachers, the personnel and chief source 
of supply in Bridgeport remains about the same as in 1912. Our City 
Normal School produces most of the additional teachers placed in the 
grammar school grades. A well-arranged study program has been intro- 
duced for teachers requiring application to approved courses for ad- 
vancement in salary, and this has probably resulted in a more wide- 
awake teaching body than we had in 1912. 

These changes, however, could hardly have effected on their own 
account the phenomenal reduction in retardation that has occurred in 
the period stated. The most sanguine advocate would hardly take the 
grounds that such a remarkable change had been efifected simply by 
the introduction late in the period under discussion of modified courses 
of study. There must have been other contributing factors with a large 
influence. 

Our dental work has called attention to the necessity of taking into 
account the child's well being. For the greater part gf the period of 
this demonstration this work stood practically alone ,in any progressive 
health movement. During the latter part it has been aided by the City 
Health Department with an enlarged force of nurses, and at the present 
time the Superintendent of Public Schools is planning a Health Program 
to be introduced into the grammar schools in September as a big, serious 
effort in recognition of the fundamental physical basis for all education. 

15 



He says : "The dental clinic has been without question a great factor in 
the health of the children, and, therefore, must have been one of the 
factors in reducing the condition of retardation, which figures show have 
been reduced 50 per cent, since November, 1912. Our promotions now 
are better than normal." 

With all these facts balanced it seems only fair to conclude that while 
the work of the Dental Division in the public schools is somewhat intan- 
gible, it has had a very marked effect upon a more normal promotion 
of children, since the change cannot be explained by other factors. 

(Zomttiunicdble Diseases 

The forms of communicable diseases where mouth hygiene could play 
an important part for prevention are those which involve the respiratory 
tract or find ingress to the body through the mucous membrane lining 
the mouth, throat and nares. The resistance to bacterial invasion may 
not be determined entirely by the contents of the blood, but by the tone 
and resistance of the cells of the individual tissues on which the bacteria 
may lodge temporarily. One bacterium does not produce a disease. 
It is only when the environment proves favorable for their propagation 
and the production of large numbers that infection occurs. 

Any continuous effort that has for its object the removal of dead 
animal and vegetable matter, such as food debris, from all the surfaces 
of all the teeth, the stimulating and keeping up of the tone of the mem- 
brane lining the mouth, and the reducing of the number of bacteria in 
the mouth to a minimum, must act as a powerful preventive by aiding 
the tonsils, the soft palate, and the pharynx to maintain a normal and 
healthful condition. 

Conversely, those mouths which are neglected and contain decayed 
teeth with decomposing food, red and congested gums, enlarged tonsils 
and a palate and pharynx covered by an irritated and partly congested 
mucous membrane, present an ideal field for the lodgment and incuba- 
tion of the pathogens. How much of the communicable diseases that 
gain ingress through the mouth will finally be eliminated from child 
life in our public school system by an enforced system of mouth hygiene 
is still a question, but all evidence seems to show that a clean mouth 
with sound teeth is the one most important factor for prevention. 

Up to a short time ago we had no tangible records in the Depart- 
ment of Health that pertained to communicable diseases in the children 
of our public schools, whereby comparisons could be made from year to 

16 



year of an increase or decrease in the numbers of these diseases. It is, 
therefore, impossible at the present time to show what obtained in the 
schools four or five years ago in comparison with what obtains today. 
Out of the death rates from all causes in this city we have been able 
to find records of three diseases which are so common among children, 
namely, diphtheria, measles and scarlet fever. These are figured on a 
basis of per 100,000 population, and show the following per cents : — 

1914 1918 

Diphtheria 36.6% 18.7% 

Measles 20. 4.1 

Scarlet fever 14.1 .5 

From the death rate tables the general inference must be that the 
percentage of communicable diseases is gradually decreasing. 

Tnfluetiza 

The record of Bridgeport during the great scourge of influenza was 
an exceptionally good one. The deaths amounted to 5.2 per cent, per 
1,000 population. This is the lowest record we have been able to find 
as yet in cities approaching the size of Bridgeport. 

The City Health Officer took the stand that since influenza was 
spread by the expelled secretions of the mouth and respiratory tract, 
the greatest means of suppressing this disease would be the knowledge 
of children and adults of the dangers of coughing, sneezing and spitting. 
He inaugurated an intensive educational campaign in theatres, motion 
picture houses and at all public gatherings regarding the contraction 
and spread of influenza. During this period he stated that an intelli- 
gent background for this education had been prepared by the regular 
work of the dental clinic in instructing children individually and in dis- 
tributing thousands of hygiene pamphlets in the homes for the enlighten- 
ment of the parents, regarding common ways of spreading diseases and 
the hygiene of prevention. Five years of such education in conjunction 
with mouth hygiene, played an important part in giving our citizens, 
as a whole, a more intelligent impression regarding contagious diseases, 
and the health officer and his co-workers had a more enlightened public 
to work with. He states further that "the most important side of this 
work is the educational opportunities afforded the hygienist. She is an 
important factor in raising the sanitary intelligence of the community, 
which is, after all, the object for which modern health workers are 
striving." 

17 



Summary 

To summarize : we have found that in schools or districts where 
Httle or no attention has been given to mouth hygiene it is difficult to 
find three children out of a hundred with teeth entirely free from dental 
caries. We have also found that, owing to this lack of education and 
enlightenment, not more than ten per cent, of the children were using 
a tooth brush daily. That malocclusion, which means that the teeth are 
out of their normal position in the mouth, thus preventing their striking 
the teeth in opposition, as nature intended they should strike, is as com- 
mon as dental caries. 

That retardations are greatly influenced by the toxic effect pro- 
duced by numerous bacteria in unclean mouths and in diseased and 
pulpless teeth. 

Although properly tabulated records of the Board of Health do not 
date back far enough to show facts and figures regarding communicable 
diseases, yet we have sufficient data which, on close observation, con- 
vinced us that mouth hygiene is to be a very powerful factor in the 
restriction of communicable and infectious diseases in childhood. 

For years the dental profession has appreciated 

Che Dattaers ^^^ toxic influence on the system of unsanitary 

Trom Tocal mouths and the dangers presented to the individual 

TnfectiOttS by such mouths incubating hundreds of millions of 

bacteria. It has been apparent that among adults 

infections of the system were taking place around the necks of the teeth, 

through the inflamed and diseased tissues which support the teeth, but 

it was not until the X-ray revealed the infected areas at the ends of the 

roots that dentistry appreciated to the utmost the seriousness of neglected 

mouths and pulpless teeth. These apical infections are difficult for the 

layman to understand, because they produce no soreness, no pain, no 

inflammation, no pus. They are caused by a type of bacteria known as 

the streptococcus viridans, which is quite friendly and harmless in the 

mouth, and which belongs to the saprophytic class. When a pulp dies in 

a tooth these bacteria commonly gain ingress through the root canal of 

a tooth to the apex, or out into that area where the tissues are bathed 

with the body juices or serum. In this new environment they gradually 

change their nature and instead of securing their food from dead animal 

or vegetable matter, such as they found in the mouth around the teeth, 

18 



they are now enabled to obtain their nourishment from the blood serum 
which surrounds them. 

Like all bacteria, they exude waste matter from 
JfCtion of the their bodies, which is a toxin ; but these bacteria, 

Bacterial toxin being of low virulency, do not create as vicious a 

toxin as many of the pathogens. However, the 
toxin is of sufficient irritation to cause theosteoclasts to break down and 
absorb the bony wall around the end of a root of a tooth, which destruc- 
tion of bone may be readily seen in the X-ray picture. This toxin is ab- 
sorbed by the lymphatic vessels and its presence in the blood undoubtedly 
excites the production of an anti-toxin which neutralizes this poison 
and may successfully control it for years. As long as the individual 
maintains normal health and the anti-toxin is produced in sufficient 
abundance to act as a neutralizer these infected areas remain harmless. 

The longer these bacteria live in this environ- 
JlCtton Of the ment of serum, the more aggressive they become, 

Bacteria and although they do not seem to take on the viru- 

lency of a true pathogen, yet when the bodily re- 
sistance becomes lowered they make the trip from the end of the root 
of a tooth, through the lymphatics and into the blood stream. These 
micro-organisms vary in their affinity for certain tissues, some finding 
the valves or the lining membrane of the heart the most favorable, others 
the kidneys, while still another class may locate in the joints. In fact, 
these seems to be no limit to the organs or tissues in which the various 
members of this family may find a congenial habitat. Having once lo- 
cated in a favorable environment in the body, they again form colonies, 
and, exuding their toxin, so poison and lower the activities of the cells 
of the tissues upon which they are located that these cells eventually 
find it impossible to properly functionate and carry on their individual 
work, and we have the beginning of a diseased tissue or organ of the 
body. It is because the action of these saprophytes is so slow and 
possesses such a low virulency that the medical and dental professions 
at large have failed to grasp, as yet, what a terrible menace these focal 
infections are to human life, and again the sad fact is that they are so 
exceedingly common, for nearly every adult has one or more pulpless 
teeth in his mouth, and nearly every adult will show under the X-ray 
affected areas above such pulpless teeth. If the resistance remains high 
they may carry such infection for ten — yes, twenty — years, but a colony 
of these bacteria living within bone tissue and exuding their toxin into 
the blood stream will sooner or later create systemic disturbance, which, 

19 



if not taken in time, will mean the beginning of the end. Recently the 
writer has been demonstrating for his own satisfaction whether the 
streptococcus viridans found in these infections had developed the na- 
ture of a pathogen. In a number of cases cultures made from infected 
roots proved fatal within forty-eight hours after their injection into 
mice. 

With these thoughts in mind, it must, in the near future, be recog- 
nized that a toothache is a calamity, for most toothache means that decay 
has already reached the pulp, and a dead pulp means danger of apical 
infection. The best root filling we know of is a live pulp. Therefore,, 
the effort must be made to prevent decay from penetrating deep enough 
in a tooth to involve a pulp. 

When these various pernicious mouth conditions are more fully un- 
derstood as the one greatest factor for producing disease, medicine will 
then acknowledge dentistry as its greatest specialty. Also, from a prophy- 
lactic standpoint, will mouth hygiene be considered the most important 
branch of general hygiene. 

It must soon be apparent to educators in our 
Tmcortancc of a public school system throughout the country that a 
1)Caltl) Program health program of considerable magnitude is essen- 
in Public Schools tial in these schools for the prevention and correc- 
tion of remediable physical defects among the chil- 
dren. These defects, if neglected, may eventually be the cause of the 
child's disability, and in later life can have a detrimental action, morally, 
mentally and physically. No longer can they specialize on mental devel- 
opment and leave the body of the child entirely in charge of home influ- 
ence. The findings of our draft boards have conclusively shown us the 
fallacy of such procedure. If we study the following table submitted 
by General March, of the U. S. Army, compiled from the data collected 
by the draft boards, we will see that there has been dire neglect in the 
supervision of the child's body: 

"The effectives at ages twenty-one to thirty, for approximately ten 
million men, in 1917 were : 

21 years 46% 26 years 29% 

22 years 43 27 years 27 

23 years 39 28 years 26 

24 years 35 29 years 23 

25 years 32 30 years 22 

The effectives at the ages thirty-two to thirty-six drop to less than 
15%." 

20 



Special attention is called to the rapid accumulative effect of physical 
disability after the adult passes thirty years of age. 

Dr. Osier has stated that the diseases of which we die in adult life 
are those which are contracted or made possible in early youth. 

The figures in General March's table would seem to corroborate state- 
ments repeatedly made by pathologists that after thirty years of age 
physical resistance to disease is on the decline, and in the vast majority 
of people can only be maintained in middle life by healthful habits and 
freedom from physical defects that permit bacterial invasion into the 
system. 

This demonstration has provided sufficient data to convince us that 
every community, sooner or later, must adopt some plan, preferably one 
of prevention, to establish clean mouths and sound teeth for school 
children. 

We know of no one movement, from the health standpoint, that would 
be more beneficial to the nation at large than a serious educational cam- 
paign to eliminate dental caries, as far as would be possible. There is 
much in this work that cannot be measured in figures, especially the moral 
uplift which comes to the individual when he is taught the importance 
of cleanliness and a wholesome respect for his body. 

The prevention of diseases such as syphillis, tuberculosis, dental caries, 
etc., will come, not through any specific form of medication or treatment, 
but chiefly through education and enlightenment. Books, pamphlets, arti- 
cles in magazines and newspapers, all are of great value in disseminating 
knowledge ; but for actual tangible results in eventually reaching all mem- 
bers of a community, nothing will compare with thoroughly spreading 
such knowledge among the children in our public school system. 

The results, as shown in this report, may be obtained in practically 
any section of the country if the hygienists and supervisors in charge of 
the work are sufficiently educated in their specialty. It must be clearly 
understood that although the dental corps has been guided in its work, 
what has been accomplished has been mainly through its own intelligent 
individual effort and not through any coercion of the teachers by the 
educational authorities in charge of the school system. This demonstra- 
tion was conducted along these lines under the least favorable circum- 
stances purposely to prove the real efficacy of prevention. It is our 
hope that from now on a definite health program will be introduced into 
our school system in Bridgeport that will give the teachers a greater 
appreciation of the importance of sound bodies for the children, thus 
securing a complete co-operation and interest on their part in this most 
important phase of child welfare. 

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029 453 107 5 



Consolidated 




Dental Mfg. Co. 



